1
Preparing for
the NCLEX®
In this chapter,
you’ll learn:
✐ why you must take
the NCLEX
✐ what you need to
know about taking
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the NCLEX by
computer
✐ strategies to use
when answering
NCLEX questions
✐ how to recognize
and answer NCLEX
alternate-format
questions
✐ how to avoid common
mistakes when
taking the NCLEX.
NCLEX basics
Passing the National Council Licensure
Examination (NCLEX®) is an important land
mark in your career as a nurse. The first step
on your way to passing the NCLEX is to under
stand what it is and how it’s administered.
NCLEX structure
The NCLEX is a test written by nurses who,
like most of your nursing instructors, have
an advanced degree and clinical expertise in
a particular area. Only one small difference
distinguishes nurses who write NCLEX ques
tions: They’re trained to write questions in a
style particular to the NCLEX.
If you’ve completed an accredited nursing
program, you’ve already taken numerous
tests written by nurses with backgrounds and
experiences similar to those of the nurses
who write for the NCLEX. The test-taking
experience you’ve already gained will help
you pass the NCLEX. So your NCLEX review
should be just that — a review. (For eligibility
and immigration requirements for nurses
from outside of the United States, see Guide
lines for international nurses, page 4.)
What’s the point of it all?
The NCLEX is designed for one purpose:
namely, to determine whether it’s appropriate
for you to receive a license to practice as a
nurse. By passing the NCLEX, you demon
strate that you possess the minimum level of
knowledge necessary to practice nursing safely.
Mix ’em up
In nursing school, you probably took courses
that were separated into such subjects as
pharmacology, nursing leadership, health
assessment, adult health, pediatric, maternal
neonatal, and psychiatric nursing. In contrast,
the NCLEX is integrated, meaning that differ
ent subjects are mixed together.
As you answer NCLEX questions, you
may encounter clients in any stage of life,
from neonatal to geriatric. These clients —
clients, in NCLEX lingo — may be of any
background, may be completely well or
extremely ill, and may have any disorder.
Client needs, front and center
The NCLEX draws questions from four cat
egories of client needs that were developed
by the National Council of State Boards of
Nursing (NCSBN), the organization that spon
sors and manages the NCLEX. Client needs
categories ensure that a wide variety of topics
appear on every NCLEX examination.
The NCSBN developed client needs cat
egories after conducting a practice analysis
of new nurses. All aspects of nursing care
observed in the study were broken down into
four main categories, some of which were
broken down further into subcategories. (See
Client needs categories, page 5.)
The whole kit and caboodle
The categories and subcategories are used
to develop the NCLEX test plan, the content
guidelines for the distribution of test ques
tions. Question-writers and the people who
put the NCLEX together use the test plan and
client needs categories to make sure that a
full spectrum of nursing activities is covered
in the examination. Client needs categories
appear in most NCLEX review and question
and-answer books, including this one. As a
test-taker, you don’t have to concern yourself
with client needs categories. You’ll see those
categories for each question and answer in
this book, but they’ll be invisible on the actual
NCLEX.
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4 Preparing for the NCLEX
Guidelines for international nurses
To become eligible to work as a registered nurse in the United States, you’ll need to complete sev
eral steps. In addition to passing the NCLEX® examination, you may need to obtain a certificate and
credentials evaluation from the Commission on Graduates of Foreign Nursing Schools (CGFNS)
and acquire a visa. Requirements vary from state to state, so it’s important that you first contact the
Board of Nursing in the state where you want to practice nursing.
CGFNS CERTIFICATION PROGRAM
Most states require that you obtain CGFNS
certification. This certification requires:
• review and authentication of your credentials,
including your nursing education, registration,
and licensure
• passing score on the CGFNS Qualifying Exami
nation of nursing knowledge
• passing score on an English language profi
ciency test.
To be eligible to take the CGFNS Qualifying
Examination, you must complete a minimum
number of classroom and clinical practice hours
in medical-surgical nursing, maternal-infant
nursing, pediatric nursing, and psychiatric
and mental health nursing from a government
approved nursing school. You must also be
registered as a first-level nurse in your country
of education and currently hold a license as a
registered nurse in some jurisdiction.
The CGFNS Qualifying Examination is
a paper and pencil test that includes 260
multiple-choice questions and is adminis
tered under controlled testing conditions.
Because the test is designed to predict
your likelihood of successfully passing the
NCLEX-RN examination, it’s based on the
NCLEX-RN test plan.
You may select from three English profi
ciency examinations—Test of English as a
Foreign Language (TOEFL®), Test of English
for International Communication (TOEIC®), or
International English Language Testing System
(IELTS). Each test has different passing
scores, and the scores are valid for up to
2 years.
CGFNS CREDENTIALS EVALUATION SERVICE
This evaluation is a comprehensive report that
analyzes and compares your education and
licensure with U.S. standards. It’s prepared by
CGFNS for a state board of nursing, an immigra
tion office, employer, or university. To use this
service you must complete an application, submit
appropriate documentation, and pay a fee.
More information about the CGFNS
certification program and credentials evaluation
service is available at www.cgfns.org.
VISA REQUIRED
You can’t legally immigrate to work in the
United States without an occupational visa
(temporary or permanent) from the United
States Citizenship and Immigration Services
(USCIS). The visa process is separate from
the CGFNS certification process, although
some of the same steps are involved. Some
visas require prior CGFNS certification and a
VisaScreen™ Certificate from the International
Commission on Healthc are Professions (ICHP).
The VisaScreen program involves:
• credentials review of your nursing education
and current registration or licensure
• successful completion of either the CGFNS
certification program or the NCLEX-RN to pro
vide proof of nursing knowledge
• passing score on an approved English lan
guage proficiency examination.
After you successfully complete all parts of
the VisaScreen program, you’ll receive a certif
icate to present to the USCIS. The visa granting
process can take up to one year.
You can obtain more detailed information
about visa applications at www.uscis.gov.
Testing by computer
Like many standardized tests today, the
NCLEX is administered by computer. That
means you won’t be filling in empty circles,
sharpening pencils, or erasing frantically. It
also means that you must become familiar
with computer tests, if you aren’t already.
Fortunately, the skills required to take the
NCLEX on a computer are simple enough to
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NCLEX basics
Client needs categories
Each question on the NCLEX is assigned a category based on client needs. This chart lists client
needs categories and subcategories and the percentages of each type of question that appears on
an NCLEX examination.
Category
Safe and effective care environment
Health promotion and maintenance
Psychosocial integrity
Physiological integrity
Subcategories
• Management of care
• Safety and infection control
• Basic care and comfort
• Pharmacological and parenteral
therapies
• Reduction of risk potential
• Physiological adaptation
allow you to focus on the questions, not the
keyboard.
Q&A
When you take the test, depending on the
question format, you’ll be presented with a
question and four or more possible answers,
a blank space in which to enter your answer, a
figure on which you’ll identify the correct
area by clicking the mouse on it, a series
of charts or exhibits you’ll use to select the
correct response, items you must rearrange
in priority order by dragging and dropping
them in place, an audio recording to listen to
in order to select the correct response, or a
question and four graphic options.
Percentage of
NCLEX questions
16% to 22%
8% to 14%
6% to 12%
6% to 12%
6% to 12%
13% to 19%
10% to 16%
11% to 17%
questions. The examination lasts a maximum
of 6 hours, however, so don’t waste time. If
you fail to answer a set number of questions
within 6 hours, the computer will determine
that you lack minimum competency.
Most students have plenty of time to
complete the test, so take as long as you need
to get the question right without wasting time.
But remember to keep moving at a decent
pace to help you maintain concentration.
Difficult items = Good news
If you find as you progress through the test
that the questions seem to be increasingly
difficult, it’s a good sign. The more questions
you answer correctly, the more difficult the
questions become.
Feeling smart? Think hard!
The NCLEX is a computer-adaptive test,
meaning that the computer reacts to the
answers you give, supplying more difficult
questions if you answer correctly, and slightly
easier questions if you answer incorrectly.
Each test is thus uniquely adapted to the
individual test-taker.
A matter of time
You have a great deal of flexibility with the
amount of time you can spend on individual
Some students, though, knowing that
questions get progressively harder, focus on
the degree of difficulty of subsequent ques
tions to try to figure out if they’re answering
questions correctly. Avoid the temptation to
do this, as this may get you off track.
Free at last!
The computer test finishes when one of the
following events occurs:
• You demonstrate minimum competency,
according to the computer program, which
I react to
you!
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